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Symptoms
- colicky abdominal pain
- abdominal distension
- Nausea Vomiting
- intolerant of enteral feeding
- constipation
- absent bowel sounds
Causes for Bowel Obstruction
Large Bowel Obstruction
- Tumor (usually sigmoid carcinoma)
- Volvulus (sigmoid, cecal)
- Fecal impaction
- Benign stricture (e.g. post-operative, inflammatory bowel disease)
- Abscess
Causes for Small Bowel Obstruction
- Adhesions (postoperative)
- intussusception(paediatric group)
- Hernias (external)
- Malignancy (peritoneal)
- Crohn disease
Functional causes
- Hypokalaemia
- Hyponatremia
- Hypothermia
- Hypoxia
- Diabetic ketoacidosis
- Uraemia
- Drugs (eg anticholinergics)
- General anesthesia
- Dehydration
- Sepsis (acute pancreatits)
- Trauma (head injury, spinal injury, pelvic surgery)
- Intra-abdominal infection / peritonitis
- Postoperative (ileus)
Investigations
- Blood tests FBC, U+Es, LFTs, glucose, amylase, group and save. Clotting screen if septic or on anticoagulants
- Plain film x-ray erect chest x-ray and supine abdominal x-ray
- ECG
- ABG if signs of sepsis or strangulated bowel
- Urinalysis
Specific Imaging
- CT
- Small bowel follow-through
- Water-soluble contrast enema
X-ray Finding
Small Bowel
- dilated bowel loops that are central (>3cm in diameter)
- the valvulae conniventes
Large bowel
- dilated bowel loops that are peripheral(dilatation to 6cm)
- contain haustra and contain faeces.
Management in ED
- Insert an IV cannula taking and send blood for FBC, U+Es, LFTs, Lactate, glucose, amylase, group and save
- Start an IV 1l of 0.9% Saline
- O2 and fluid resuscitation if the patient is haemodynamically unstable
- Move the patient to an appropriate area of the department and involve an ED senior in their management
- Titrate IV analgesia with an antiemetic
- Insert a naso-gastric tube and declare the patient nil by mouth (NBM)
- Insert a urinary catheter
- REFER TO THE SURGICAL TEAM
Treatment
- decompressionn using a colonoscopy
Complications
- Perforation
- Bowel ischaemia
- Peritonitis
- Sepsis
- Intra-abdominal abscess
- Fluid and electrolyte imbalance
More Reading
https://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/normal
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